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Norman JS, Testa S, Wang CX, Savage T. Milky Way: Management of Primary Intestinal Lymphangiectasia. Dig Dis Sci 2023; 68:3872-3877. [PMID: 37634185 DOI: 10.1007/s10620-023-08077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Joshua S Norman
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA.
- , Stanford, USA.
| | - Stefano Testa
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA
| | - Cindy Xinnan Wang
- Department of Pathology, Stanford University, Stanford, CA, 94304, USA
| | - Thomas Savage
- Department of Medicine, Stanford University, Stanford, CA, 94304, USA
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2
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Feng H, Zou L, Zhai X, Zhang S, Li J. Hypomagnesemia in intestinal lymphangiectasia: a case report and review of the literature. BMC Gastroenterol 2022; 22:246. [PMID: 35570283 PMCID: PMC9107688 DOI: 10.1186/s12876-022-02318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intestinal lymphangiectasia (IL) is a rare disease characterized by dilation of lymphatic vessels and leakage of lymphatic fluids into the intestinal lumen, causing depletion of lymphocytes, protein, lipids, fat-soluble vitamins, and electrolytes. Hypomagnesemia can occur in IL patients but is seldom discussed. CASE PRESENTATION A 30-year-old Tibetan woman who had chronic diarrhea, edema, tetany, and tingling was diagnosed with IL. Prominent hypomagnesemia was noticed. She was treated with a medium-chain triglyceride (MCT) diet and nutrient supplementation with satisfactory results. We also present a systematic review of hypomagnesemia in IL cases from the published literature. CONCLUSIONS Hypomagnesemia may be an overlooked complication of IL, thus monitoring serum magnesium concentrations in IL patients is crucial.
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Affiliation(s)
- Hao Feng
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Linfeng Zou
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiao Zhai
- Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shengyu Zhang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Jingnan Li
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
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3
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Kwon Y, Kim ES, Choe YH, Hyun D, Kim MJ. Therapeutic Lymphatic Embolization in Pediatric Primary Intestinal Lymphangiectasia. Yonsei Med J 2021; 62:470-473. [PMID: 33908219 PMCID: PMC8084696 DOI: 10.3349/ymj.2021.62.5.470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/27/2022] Open
Abstract
Primary intestinal lymphangiectasia (IL) can cause leakage of lymphatic fluids into the gastrointestinal tract, eventually leading to protein-losing enteropathy. A 15-year-old male patient, whose disease began at the age of 8 years, recently felt worsening general weakness. After diagnosing abnormal lymphatic lesions in the duodenum through endoscopy with biopsy and contrast-enhanced magnetic resonance lymphangiography, glue embolization of the leaking duodenal lymphatic channel was successfully performed. This procedure is typically reserved for adult patients, although as shown in this case, it can be properly performed in children. His serum albumin level was initially 1.5 g/dL, but elevated to 5.0 g/dL after two sessions of lymphatic embolization. Accordingly, we suggest that embolization could potentially be considered a first-line treatment for focal lesions of primary intestinal IL.
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Affiliation(s)
- Yiyoung Kwon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sil Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yon Ho Choe
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Huber R, Semmler G, Mayr A, Offner F, Datz C. Primary intestinal lymphangiectasia in an adult patient: A case report and review of literature. World J Gastroenterol 2020; 26:7707-7718. [PMID: 33505146 PMCID: PMC7789053 DOI: 10.3748/wjg.v26.i48.7707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary intestinal lymphangiectasia (PIL), first described in 1961, is a rare disorder of unknown etiology resulting in protein-losing enteropathy. The disease is characterized by dilatation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia, and lymphopenia. Since the severity and location of lymph vessels being affected can vary considerably, the range of associated symptoms is wide from mild lower-limb edema to generalized edema, abdominal and/or pleural effusion, and recurrent diarrhea, among others. Although usually developing in early childhood, we present the case of a 34-year-old woman with PIL. Moreover, we performed a literature review systematically assessing clinical presentation, and provide a practical approach to facilitate diagnosis and therapy of PIL in adults.
CASE SUMMARY Our patient presented with unspecific symptoms of abdominal discomfort, fatigue, nausea, and recurrent edema of the lower limbs. Interestingly, a striking collinearity of clinical symptoms with female hormone status was evident. Additionally, polyglobulia, hypoalbuminemia, hypogammaglobulinemia, and transient lymphocytopenia were evident. Due to suspicion of a bone marrow disease, an extensive diagnostic investigation was carried out excluding secondary causes of polyglobulinemia and hypoalbuminemia. The diagnosis of primary intestinal lymphangiectasia was established after 22 wk by histological analysis of biopsy samples obtained via enteroscopy. Consecutively, the patient was put on a high-protein and low-fat diet with medium-chain triglycerides supplementation leading to significant improvement of clinical symptoms until 2 years of follow-up.
CONCLUSION PIL can be the reason for cryptogenic hypoalbuminemia, hypogammaglobulinemia, and lymphopenia in adulthood. Due to difficulty in correct diagnosis, treatment initiation is often delayed despite being effective and well-tolerated. This leads to a significant disease burden in affected patients. PIL is increasingly been recognized in adults since the majority of case reports were published within the last 10 years, pointing towards an underestimation of the true prevalence. The association with female hormone status warrants further investigation.
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Affiliation(s)
- Rudolf Huber
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
| | - Georg Semmler
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
| | - Alexander Mayr
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
| | - Felix Offner
- Department of Pathology, General Hospital Feldkirch, Feldkirch 6800, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf 5110, Austria
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Usnayo Usnayo KM, Piscoya A, Escalante Kanashiro R, Sánchez Dávila S. [Primary intestinal lymphangiectasia: first case report in Peru]. Rev Gastroenterol Peru 2019; 39:78-80. [PMID: 31042241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Primary intestinal lymphangiectasia is a rare clinical condition of unknown etiology. The common age of presentation is during the first 3 years of life, but cases in adults have also been reported. It has a variable symptomatology, but the main clinical manifestation is edema, also diarrhea and weight loss can occur. The loss of lymph fluid into the gastrointestinal tract also leads to hypoproteinemia and lymphopenia. Diagnosis is based on clinical manifestations, laboratory and endoscopic findings, and is confirmed on histopathological examination of biopsy. The main treatment is a protein rich, low in fat and medium chain triglyceride diet. We present the case of a 1-year-old male patient who presents with generalized edema, predominantly in lower limbs, and diarrhea. Laboratory findings show the presence of marked hypoproteinemia. Then an endoscopy and a duodenal biopsy are performed, and the histopathological study confirms the diagnosis of primary intestinal lymphangiectasia. The patient is treated and after a satisfactory evolution, is discharged.
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Affiliation(s)
| | - Alejandro Piscoya
- Servicio de Gastroenterología, Hospital Guillermo Kaelin de la Fuente. Lima, Perú; Vicerrectorado de Investigación, Universidad San Ignacio de Loyola. Lima, Perú
| | - Raffo Escalante Kanashiro
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas. Lima, Perú; Instituto Nacional de Salud del Niño. Lima, Perú
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Guo S, Song L, Guan DX, Mei TL, Zhou J, Yu FH, Wang GL, Zhang J, Shen HQ, Xu XW. [Clinical analysis of intestinal lymphangiectasia in 47 children]. Zhonghua Er Ke Za Zhi 2017; 55:937-941. [PMID: 29262475 DOI: 10.3760/cma.j.issn.0578-1310.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To analyze the clinical manifestations, diagnosis, treatment and prognosis of intestinal lymphangiectasia (IL) in children in order to improve the skills of diagnosis and treatment of IL. Method: Clinical manifestations, laboratory findings, gastroscopic findings, histopathological examinations and lymphatic radionuclide imaging assessments were analyzed retrospectively among 47 IL patients who were hospitalized in the Gastroenterology Department of Beijing Children's Hospital Affiliated to Capital Medical University from June 2007 to December 2015. All patients were followed up by telephone. According to the various causes, the patients were divided into the primary intestinal lymphangiectasia (PIL) group and secondary IL group, and their clinical manifestations were compared by t test, Rank sum test or Chi-square test. Result: In 47 IL patients, there were 38 children (81%) younger than 3 years old. There were 43 PIL patients (91%) and 4 secondary IL patients (9%). Between PIL and secondary IL, there were statistical differences in serum albumin (t=-3.950, P<0.005) , globulin(t=-2.850, P=0.007), age of onset(U=27.000, P=0.024), age at diagnosis(U=29.000, P=0.030) and course of disease(U=26.500, P=0.023), whereas there were no statistical differences in lymphocyte count, IgG, lymphatic radionuclide imaging, histopathology and gender(all P>0.05). Edema (44 cases, 94%), diarrhea (42 cases, 89%), accompanied with infection (35 cases, 74%) and ascites (30 cases, 64%) were the main clinical manifestations. In 47 IL patients, 45 patients were done gastroscopy and histopathological examinations, and there were 31 patients' histopathological examinations(69%) were positive. Forty patients were done lymphatic radionuclide imaging, and there was evidence of protein losing from gut via lymphatic radionuclide imaging in 39 patients(98%). Among 47 patients, 35 patients (74%) were followed up, 32 patients had good prognosis, 2 patient failed to show evidence of improvement, 1 patient died and no patient experienced a relapse till the end of the follow-up. In 35 patients, 28 patients were treated with medium chain triglycerides (MCT) dietary therapy, 26 patients showed improvement in symptoms, and 2 patients had no improvement. Among 35 patients with follow-up, there were 6 patients received surgical treatment, and their symptoms were improved. Conclusion: PIL are the majority of IL in children younger than 3 years old. The main clinical manifestations are edema, diarrhea, accompanied with infection and ascites. For the patients without the evidence of lymphangiectasia from duodenum histopathological examination, further consideration of lymphatic radionuclide imaging, clinical manifestations, and laboratory studies are needed to make a final diagnosis. MCT dietary therapy is the cornerstone of IL medical management.
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Affiliation(s)
- S Guo
- Department of Gastroenterology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
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Huber X, Degen L, Muenst S, Trendelenburg M. Primary intestinal lymphangiectasia in an elderly female patient: A case report on a rare cause of secondary immunodeficiency. Medicine (Baltimore) 2017; 96:e7729. [PMID: 28767614 PMCID: PMC5626168 DOI: 10.1097/md.0000000000007729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Protein loss via the gut can be caused by a number of gastrointestinal disorders, among which intestinal lymphangiectasia has been described to not only lead to a loss of proteins but also to a loss of lymphocytes, resembling secondary immunodeficiency. We are reporting on a 75-year-old female patient who came to our hospital because of a minor stroke. She had no history of serious infections. During the diagnostic work-up, we detected an apparent immunodeficiency syndrome associated with primary intestinal lymphangiectasia. Trying to characterize the alterations of the immune system, we not only found hypogammaglobulinemia and lymphopenia primarily affecting CD4+, and also CD8+ T cells, but also marked hypocomplementemia affecting levels of complement C4, C2, and C3. The loss of components of the immune system most likely was due to a chronic loss of immune cells and proteins via the intestinal lymphangiectasia, with levels of complement components following the pattern of protein electrophoresis. Thus, intestinal lymphangiectasia should not only be considered as a potential cause of secondary immune defects in an elderly patient, but can also be associated with additional hypocomplementemia.
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Affiliation(s)
- Xaver Huber
- Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland Medical Outpatient Department, University Hospital Basel, University of Basel, Basel, Switzerland Department of Gastroenterology and Hepatology, University Hospital Basel, University of Basel, Basel, Switzerland Institute of Pathology, University Hospital Basel, Basel, Switzerland
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Patuzzo G, Tinazzi E, Micheletti M, Puccetti A, Lunardi C. Secondary hypogammaglobulinemia in Waldmann's disease treated with subcutaneous immunoglobulins. Eur Ann Allergy Clin Immunol 2016; 48:55-57. [PMID: 26934740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary intestinal lymphangiectasia (PIL) is rare disorder characterized by congenital malformation or obstruction of intestinal lymphatic drainage; it is responsible for protein losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL management. The administration of intravenous immunoglobulins does not always lead to satisfactory plasma levels and therefore the replacement therapy with immunoglobulins is controversial. We describe here the case of a patient with PIL and severe hypogammaglobulinemia treated with immunoglobulins. The striking aspect of this case is the clinical and serological benefit obtained with the subcutaneous compared to the intravenous immunoglobulins administration.
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Affiliation(s)
- G Patuzzo
- Clinical Immunology and Allergy Unit Department of Medicine University of Verona 37134 Verona, Italy. E-mail: Phone: +39 045 812 4401 Fax: +39 045 802 7473
| | - E Tinazzi
- Department of Medicine, University of Verona, Verona, Italy
| | - M Micheletti
- Department of Medicine, University of Verona, Verona, Italy
| | - A Puccetti
- Immunology Area, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - C Lunardi
- Department of Medicine, University of Verona, Verona, Italy
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Raithel M, Rau TT, Hagel AF, Albrecht H, Rossi TD, Kirchner T, Hahn EG. Jejunitis and brown bowel syndrome with multifocal carcinogenesis of the small bowel. World J Gastroenterol 2015; 21:10461-10467. [PMID: 26420973 PMCID: PMC4579893 DOI: 10.3748/wjg.v21.i36.10461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/15/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
This is the first report describing a case where prolonged, severe malabsorption from brown bowel syndrome progressed to multifocally spread small bowel adenocarcinoma. This case involves a female patient who was initially diagnosed with chronic jejunitis associated with primary diffuse lymphangiectasia at the age of 26 years. The course of the disease was clinically, endoscopically, and histologically followed for 21 years until her death at the age 47 due to multifocal, metastasizing adenocarcinoma of the small bowel. Multiple lipofuscin deposits (so-called brown bowel syndrome) and severe jejunitis were observed microscopically, and sections of the small bowel showed dense lymphoplasmacytic infiltration of the lamina propria as well as blocked lymphatic vessels. After several decades, multifocal nests of adenocarcinoma cells and extensive, flat, neoplastic mucosal proliferations were found only in the small bowel, along with a loss of the mismatch repair protein MLH1 as a long-term consequence of chronic jejunitis with malabsorption. No evidence was found for hereditary nonpolyposis colon carcinoma syndrome. This article demonstrates for the first time multifocal carcinogenesis in the small bowel in a malabsorption syndrome in an enteritis-dysplasia-carcinoma sequence.
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal-1 waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal0'xor(if(now()=sysdate(),sleep(15),0))xor'z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal" and 2*3*8=6*8 and "7o4f"="7o4f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal' and 2*3*8=6*8 and 'yp6p'='yp6p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal-1; waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal'||'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.balvfje7w7k'); waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.baliyd4qqop')) or 505=(select 505 from pg_sleep(15))--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal'"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal-1); waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal%' and 2*3*8=6*8 and 'lroz'!='lroz%] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal����%2527%2522\'\"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.balnbcbifom] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.balax86iu7o' or 875=(select 875 from pg_sleep(15))--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal0"xor(if(now()=sysdate(),sleep(15),0))xor"z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.balsfky6kby'; waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.bal'||dbms_pipe.receive_message(chr(98)||chr(98)||chr(98),15)||'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.balaiylzh2o') or 484=(select 484 from pg_sleep(15))--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Balaban VD, Popp A, Grasu M, Vasilescu F, Jinga M. Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report. J Gastrointestin Liver Dis 2015; 24:369-373. [PMID: 26405709 DOI: 10.15403/jgld.2014.1121.243.balpyvnn1ym')); waitfor delay '0:0:15' --] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. CASE PRESENTATION We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. CONCLUSIONS Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.
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Affiliation(s)
- Vasile Daniel Balaban
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy; Alfred Rusescu Institute for Mother and Child Care, Bucharest, Romania; Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Finland.
| | - Mugur Grasu
- Fundeni Clinical Institute, Bucharest, Romania
| | - Florina Vasilescu
- Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Dr. Carol Davila Central Military Emergency University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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29
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Deng XL, Yin F, Zhang GY, Duan YD. [A complicated case study: Hennekam syndrome]. Zhongguo Dang Dai Er Ke Za Zhi 2015; 17:77-80. [PMID: 25616299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hennekam syndrome (HS) is a rare autosomal recessive syndrome characterized by defective lymphatic development. A 34-month-old boy with HS and who had unexplained developmental retardation and hypoalbuminemia as main clinical manifestations is reported here. He had a history of generalized edema and poor feeding. He was not thriving well. He manifested as facial anomalies (hypertelorism, flat nasal bridge and flat face), fracture of teeth, and superficial lymph nodes enlargement. He had low serum total protein, low serum albumin, and low serum immunoglobulin levels. Duodenal bulb biopsy revealed lymphangiectasia. Color Doppler ultrasound, magnetic resonance imaging and CT scan showed multi-site lymphangioma, and HS was thus confirmed. Mutations in CCBE1 and FAT4 have been found responsible for the syndrome in a part of patients. Diagnosis of the disease depends on the familial history, clinical signs, pathological findings and genetic tests.
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Affiliation(s)
- Xiao-Lu Deng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha 410008, China.
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30
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Park MS, Lee BJ, Gu DH, Pyo JH, Kim KJ, Lee YH, Joo MK, Park JJ, Kim JS, Bak YT. Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy. World J Gastroenterol 2013; 19:8440-8444. [PMID: 24363538 PMCID: PMC3857470 DOI: 10.3748/wjg.v19.i45.8440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/04/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery.
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31
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Khen-Dunlop N, Amiel J, Delacourt C, Révillon Y. [Enigmatic lymphatic diseases involving the lung]. Rev Pneumol Clin 2013; 69:260-264. [PMID: 23561737 DOI: 10.1016/j.pneumo.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/22/2013] [Accepted: 02/15/2013] [Indexed: 06/02/2023]
Abstract
Lymphedema associated with other developmental malformations (Milroy syndrome, Hennekam syndrome, Noonan syndrome, Gorham-Stout syndrome, yellow nail syndrome) are unfrequent disease, but explorations led to the identification of genetic mutations that have then been validated in mouse models. However, lymphatic vessels complexity and its proximity with the venous system suggest the need for further researches, especially in the comprehension of pulmonary symptoms.
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Affiliation(s)
- N Khen-Dunlop
- Service de chirurgie viscérale pédiatrique, hôpital Necker-Enfants-malades, 149, rue de Sèvres, 75015 Paris, France.
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32
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Urganci N, Gulec SG, Kalyoncu D, Karaman S. Evaluation of paediatric patients with protein losing enteropathy a single centre experience. W INDIAN MED J 2013; 62:186-189. [PMID: 24564037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate paediatric patients with protein losing enteropathy (PLE). METHODS Fourteen cases diagnosed as PLE were evaluated in terms ofaetiologies, diagnostic methods, laboratory findings, treatment procedures and long-term prognosis. RESULTS Four of the cases had coeliac disease, three intestinal lymphangiectasia, three giardia infection, one H pylori infection and three cytomegalovirus (CMV) infection. Histopathological examinations of duodenum specimens revealed total villous atrophy in four cases, lymphatic dilatation in three cases, severe nodular appearance in four cases and no pathology in four cases. All of the cases except patients with intestinal lymphangiectasia were controlled by the appropriate treatment given for the underlying disease. The cases with CMV infection were treated with only supportive treatment and gancyclovir therapy was not needed. CONCLUSION When proteinuria is not detected in well-appearing children admitted with oedema, PLE must be considered.
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Affiliation(s)
- N Urganci
- Department of Paediatric Gastroenterology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - S G Gulec
- Department of Paediatrics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - D Kalyoncu
- Department of Paediatrics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - S Karaman
- Department of Paediatrics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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33
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Guo J, Sun M. [Clinical characteristics of primary intestinal lymphangiectasia in children]. Zhongguo Dang Dai Er Ke Za Zhi 2011; 13:437-439. [PMID: 21575356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Jing Guo
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang 110004, China
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34
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Hu J, Li HP, Song ZZ. [A case report of primary-intestinal-lymphangiectasia suffered from bilateral femoral neck facture]. Zhongguo Gu Shang 2010; 23:142-143. [PMID: 20345044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Jian Hu
- The 1st Department of Orthopaedics, the 401 Hospital of PLA, Qingdao 266071, Shandong, China.
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35
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Suresh N, Ganesh R, Sankar J, Sathiyasekaran M. Primary intestinal lymphangiectasia. Indian Pediatr 2009; 46:903-906. [PMID: 19887697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Primary intestinal lymphangiectasia (PIL) is a rare disease of intestinal lymphatics presenting with hypoproteinemia, bilateral lower limb edema, ascites, and protein losing enteropathy. We report a series of 4 children from Chennai, India presenting with anasarca, recurrent diarrhea, hypoproteinemia and confirmatory features of PIL on endoscopy and histopathology.
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Affiliation(s)
- N Suresh
- Departments of Pediatrics and Gastroenterology, Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai, Tamil Nadu, India.
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36
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Kinani A, Havelund T, Knudsen T. [Protein-losing enteropathy caused by a thoracic cyst]. Ugeskr Laeger 2009; 171:2573-2574. [PMID: 19732551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A case of gastrointestinal protein loss in a 58-year-old man presenting with peripheral oedema and low levels of serum proteins is presented. Measurement of gastrointestinal protein loss with 111Indium-labelled transferrin showed a protein loss of 12.5% over 96 hours. Capsule endoscopy showed villous lymphangiectasia and it was assumed that the protein loss was secondary to a large left-sided thoracic cyst obstructing the thoracic lymph drainage. The patient improved following surgical removal of the cyst.
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Affiliation(s)
- Atef Kinani
- Medicinsk Gastroenterologisk Afdeling, Medicinsk Område, Sydvestjysk Sygehus, Esbjerg, DK-6700 Esbjerg.
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37
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Tourlakis D, Hatziveis K, Spiliopoulos E. Pregnancy and Waldmann disease. Clin Ter 2008; 159:173-174. [PMID: 18594747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We present a case of a woman with intestinal lymphangiectasia and pregnancy. She had been treated with albumin transfusions beginning from the age of 2 years. No major complications were caused to the pregnancy. During pregnancy she was given albumin transfusions at regular intervals, while measuring total proteins, albumin and calcium concentrations in the serum. Due to the increasing needs in proteins as the pregnancy went on, the interval between each transfusion went decreasing. Finally, at 39 weeks of gestation she gave birth by cesarean section due to placenta previa to a healthy female fetus. A worsening of hypoproteinemia and edema was noted during puerperium and lactation. Weaning improved her clinical status. The baby was followed by pediatricians and found her in good health. Summing up, normal pregnancy is compatible with the condition. A strict maternal and fetal care during pregnancy and puerperium is recommended.
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Affiliation(s)
- D Tourlakis
- Obstetric, Gynecologic Clinic St. Andrews hospital, Patra, Greece.
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38
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Lee J, Kong MS. Primary intestinal lymphangiectasia diagnosed by endoscopy following the intake of a high-fat meal. Eur J Pediatr 2008; 167:237-9. [PMID: 17453239 DOI: 10.1007/s00431-007-0445-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 02/07/2007] [Indexed: 12/18/2022]
Affiliation(s)
- Jung Lee
- Division of Paediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Graduate Institute of Clinical Medical Sciences Chang Gung University, 5 Fu-Hsin St. KueiShan, Taoyuan, Taiwan
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39
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Affiliation(s)
- Marco Pennazio
- Gastroenterology Unit 2, Department of Gastroenterology and Clinical Nutrition, S. Giovanni A.S. Hospital, Torino, Italy
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40
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Abstract
Gastrointestinal complications of Waldenstrom macroglobulinemia (WM) are unusual but often treatable. We report a case of WM associated with significant gastrointestinal involvement manifest as chronic diarrhea with protein-losing enteropathy and recurrent venous thromboses. Small bowel biopsy was negative for amyloidosis but revealed intestinal lymphangiectasia with deposition of monoclonal IgM. The patient was treated with cyclophosphamide, vincristine, and prednisone with rapid and complete resolution of the peripheral edema and diarrhea. We follow the case report with a retrospective analysis of patients with WM and gastrointestinal symptoms seen at our institution, and review the available literature on this unusual association. An increased awareness of the gastrointestinal manifestations of WM may help to explain and to treat the chronic, debilitating, and potentially life-threatening symptoms in patients with this lymphoproliferative disorder.
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Affiliation(s)
- Keith W Pratz
- From Department of Medical Oncology (KWP), Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland; Division of Hematology (DD, JAL), Department of Internal Medicine; and Department of Laboratory Medicine and Pathology (TCS), Mayo Clinic College of Medicine, Rochester, Minnesota
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41
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Hosoyamada T. [Clinical studies of pediatric malabsorption syndromes]. Fukuoka Igaku Zasshi 2006; 97:322-50. [PMID: 17228786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Multiple cases with various types of pediatric malabsorption syndromes were evaluated. The clinical manifestations, laboratory findings, pathophysiology, and histopathological descriptions of each patient were analyzed in an effort to clear the pathogenesis of the malabsorption syndromes and the treatments were undertaken. The cases studied, included one patient with cystic fibrosis, two with lactose intolerance with lactosuria (Durand type), one with primary intestinal lymphangiectasia, two with familial hypobetalipoproteinemia, one with Hartnup disease, one with congenital chroride diarrhea, one with acrodermatitis enteropathica, one with intestinal nodular lymphoid hyperplasia (NLH), five with intractable diarrhea of early infancy and four with glycogenosis type Ia. Each case description and outcome is described below: 1. A 15-year-old Japanese boy with cystic fibrosis presented with severe symptoms, including pancreatic insufficiency, bronchiectasis, pneumothorax and hemoptysis. His prognosis was poor. Analysis of the CFTR genes of this patient revealed a homozygous large deletion from intron 16 to 17b. 2. In the sibling case of Durand type lactose intolerance, the subjects'disaccaridase activity of the small bowel, including lactase, were within normal limits. The results of per oral and per intraduodenal lactose tolerance tests confirmed lactosuria in both. These observations suggested, not only an abnormal gastric condition, but also duodenal and intestinal mucosal abnormal permeability of lactose. 3. In the case of primary intestinal lymphangiectasia, the subject had a lymphedematous right arm and hand, a grossly coarsened mucosal pattern of the upper gastrointestinal tract (identified via radiologic examination) and the presence of lymphangiectasia (confirmed via duodenal mucosal biopsy). The major laboratory findings were hypoalbuminemia, decreased immunoglobulin levels and lymphopenia resulting from loss of lymph fluid and protein into the gastro-intestinal tract. 4. In two cases of heterozygous familial hypobetalipoproteinemia, serum total cholesterol and betalipoprotein levels were very low. The subjects presented with symptoms and signs of acanthocytosis and fat malabsorption. Further, one subject had neurological abnormalities such as mental retardation and severe convulsions. Treatment with MCT formula diet corrected the lipid malabsorption. 5. A 5-year-old girl presented with pellagra-like rashes, mental retardation and cerebellar ataxia. An oral tryptophan (Trp) and dipeptide (Trp-Phe) loading test were conducted and the renal clearance of amino acids was also evaluated in this patient and in controls. Following the oral Trp loading test, plasma levels of Trp indicated a lower peak in the case, reaching a maximum at 60 minutes. On the other hand, the oral dipeptide (Trp-Phe) loading test in the Hartnup patient showed the peak Trp plasma level was the same as the control subjects. The renal clearance of neutral amino acids in this case increased to levels 5 to 35 times normal. 6. In the case of congenital chloride diarrhea, the subject had secondary lactose intolerance, dehydration, hyponatremia, hypokalemia, hypochloremia, hyperreninemia and metabolic alkalosis. The chloride content of her fecal fluid was very high. The concentrations were 89-103 mEq/l. In contrast, her urine was chloride-free. The subject's growth and development improved after treatment with lactose free formura and oral replacement of the fecal loses of water, NaCl and KCl. Unfortunately, the patient died of a small bowel intussusception. The kidney histopathological finding was juxtaglomerular hyperplasia by a necropsy. 7. In the case of acrodermatitis enteropathica, the subject had characteristic skin lesions, low serum zinc levels and ALPase activity. An oral ZnSO4 loading test and intestinal mucosal histology by a peroral biopsy were conducted. The serum zinc peak level was 2 hours after the oral ZnSO4 loading test. Infant formula alone could not maintain normal serum zinc ranges. Light microscopic studies of the intestinal villous architecture showed a normal pattern. However, ultrastructual examination of several epithelial cells revealed numerous intracellular vesicles. After zinc therapy, these changes were decreased. The lesions were postulated as the secondary result of zinc deficiency. 8. A 12-year-old girl presented with hypogammaglobulinemia, recurrent infections, chronic diarrhea and intestinal NLH. A barium meal and follow-through examination showed multiple nodules throughout the stomach and intestine. The nodules, all uniform in size, were 2 mm diameter. The barium enema did not show NLH in the colon. Mucosal biopsy of the stomach and jejunum revealed the typical histology of NLH in the lamina propria. Also, achlorhydria was present in this patient and her serum gastrin levels were very high; 315-775 pg/ml. 9. In 4 cases of intractable diarrhea in early infancy (by Avery G B), a jejunal biopsy showed shortening villi and nonspecific enterocolitis. Some patients were found with only low lactase or low lactase and sucrase levels. An electron microscope analysis of the small bowel in 2 cases showed alterations: increased pinocytosis in microvillus membranes and lysosomes by endocytosis of undigested macromolecular substances. I postulated that the stated evidence was causative of this clinical profile. 10. I frequently observed diarrhea as a clinical manifestation in glycogenosis type Ia and lipid malabsorption in one case. The light and electron photomicrographs showed intestinal absorption cells with the glycogen deposits in the inferior devision of nuclei.
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MESH Headings
- Acrodermatitis/complications
- Acrodermatitis/diagnosis
- Acrodermatitis/therapy
- Adolescent
- Castleman Disease/complications
- Castleman Disease/diagnosis
- Castleman Disease/therapy
- Child
- Child, Preschool
- Cystic Fibrosis/complications
- Cystic Fibrosis/diagnosis
- Cystic Fibrosis/therapy
- Diarrhea/complications
- Diarrhea/congenital
- Diarrhea/diagnosis
- Diarrhea/therapy
- Diarrhea, Infantile/complications
- Diarrhea, Infantile/diagnosis
- Diarrhea, Infantile/therapy
- Female
- Glycogen Storage Disease Type I/complications
- Glycogen Storage Disease Type I/diagnosis
- Glycogen Storage Disease Type I/therapy
- Hartnup Disease/complications
- Hartnup Disease/diagnosis
- Hartnup Disease/therapy
- Humans
- Hypobetalipoproteinemia, Familial, Apolipoprotein B/complications
- Hypobetalipoproteinemia, Familial, Apolipoprotein B/diagnosis
- Hypobetalipoproteinemia, Familial, Apolipoprotein B/therapy
- Infant
- Infant, Newborn
- Lactose Intolerance/complications
- Lactose Intolerance/diagnosis
- Lactose Intolerance/therapy
- Lymphangiectasis, Intestinal/complications
- Lymphangiectasis, Intestinal/diagnosis
- Lymphangiectasis, Intestinal/therapy
- Malabsorption Syndromes/etiology
- Malabsorption Syndromes/therapy
- Male
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Heruth M, Müller P, Liebscher L, Kurze G, Richter T. [Exudative enteropathy in congenital lymphedema-lymphangiectasia syndrome]. Klin Padiatr 2006; 218:27-30. [PMID: 16432772 DOI: 10.1055/s-2004-832486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Congenital peripheral elephantiasiformic alterations are very rare in paediatric patients. In a patient with lymphangiectasia-lymphedema syndrome we demonstrate over a 8-year follow-up that not only cosmetic and social indications for surgical treatments but also internal care become important during the course. PATIENT We report on a boy with congenital lymphedemas of the extremities and the genital region, which were several times surgically treated. The patient became symptomatic firstly with tetanic cramps caused by malabsorption syndrome due to intestinal lymphangiectasia at the age of 6 years. Synopsis of clinical and laboratory findings and the patient's course are pointing to a mild Hennekam syndrome with still unknown aetiology. RESULTS The boy developed adequately with permanent oral substitution of electrolytes and vitamins, protein-rich diet, supplementation of medium-chain fatty acids and compressing bandages. Infusions of human albumin to correct persistent hypalbuminemia as well as cytostatic treatment with cyclophosphamide as a formal trial were ineffective and are not advisable, therefore.
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Affiliation(s)
- M Heruth
- Abt. Kinder- und Jugendmedizin, HELIOS Krankenhaus, Leisnig
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43
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Buckley RH. Primary immunodeficiency or not? Making the correct diagnosis. J Allergy Clin Immunol 2006; 117:756-8. [PMID: 16630930 DOI: 10.1016/j.jaci.2006.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 01/09/2006] [Accepted: 01/11/2006] [Indexed: 11/22/2022]
Abstract
Making a correct diagnosis of a primary immunodeficiency disease is crucial for the selection of proper therapy. Although many cases go undiagnosed, there are also many instances of incorrect diagnosis that result in years of inappropriate treatment and failure to implement beneficial treatment. This article summarizes 2 actual cases in which incorrect diagnoses led to recommendations of unwarranted high-risk or costly treatments. Had the physicians chosen tests of immune function rather than relying on immunoglobulin levels or cell counts, they would have arrived at the true diagnoses.
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44
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Rodríguez Leal G. Intestinal lymphangiectasia: a forgotten cause of chronic diarrhea. Rev Gastroenterol Mex 2006; 71:55-8. [PMID: 17061479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Intestinal lymphangiectasia is a rare autosomal dominant disorder or acquired condition that leads to lymph obstruction, poor chyle transport and concomitant problems. We describe the cases of two women with chronic diarrhea in whom the common signs of lymphagiectasia-hypoalbuminemia, lymphopenia and distal edema- were found. One of them also had pleural effusion and chylous ascites. The diagnosis was performed by intestinal biopsy. We herein review the histopathologic, radiographic and endoscopic features of this disorder and case reports in Mexican population.
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Affiliation(s)
- Gustavo Rodríguez Leal
- Clínica de Gastroenterología, Hospital Médica Sur, Instituto Mexicano del Seguro Social, México, DF.
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45
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Bonny O, Marti HP. Eine ungewöhnliche Ursache für Ödeme der unteren Extremitäten! Therapeutische Umschau 2004; 61:691-5. [PMID: 15605463 DOI: 10.1024/0040-5930.61.11.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ein 31-jähriger Patient wurde uns zur Abklärung von massiven Unterschenkelödemen mit Hypoalbuminemie, aber ohne Proteinurie zugewiesen. Die Differentialdiagnose, das diagnostische Prozedere und das klinische Management werden diskutiert, ohne die Diagnose bereits jetzt zu verraten. Verschiedene Therapie-Möglichkeiten bei unserer ungewöhnlichen Ödemform sind in der Literatur beschrieben. Im klinischen Alltag sind Ödeme ein häufiger klinischer Befund und deren Ursache oft gut eruierbar. Hin und wieder gibt es aber seltenere Knacknüsse!
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Affiliation(s)
- O Bonny
- Klinik und Poliklinik für Nephrologie und Hypertonie, Inselspital, Bern.
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46
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Hamada A, Kondoh T, Kamei T, Tominaga N, Tsuru A, Matsumoto T, Matsuzaka T, Moriuchi H. Protein-losing enteropathy complicated with recurrent convulsions and developmental delay in a 4-month-old boy. Pediatr Int 2002; 44:686-9. [PMID: 12421272 DOI: 10.1046/j.1442-200x.2002.01624.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ayako Hamada
- Department of Pediatrics, Nagasaki University School of Medicine, Nagasaki, Japan
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47
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Affiliation(s)
- K Becker
- Klinik für Innere Medizin und Gastroenterologie, Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf, Germany.
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Monasteri R, Werth B, Brunner W, Reinhart WH. [Post-actinic jejunal lymphangiectasis: a rare case of malabsorption]. Schweiz Med Wochenschr 2000; 130:1848-53. [PMID: 11132529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
We report the case of a 63-year-old male hospitalised for chronic diarrhoea and weight loss of 11 kg within 2 years. The symptoms began after a trip to Thailand. Various investigations were negative and led to the assumption of tropical sprue, which was treated with tetracycline. Within 4 months the malabsorption deteriorated and the patient was readmitted with severe electrolyte imbalance. CT-scan of the abdomen revealed a thickened intestinal wall in the jejunum. Diagnostic laparotomy was performed and, surprisingly, revealed chylascites. Histology in a segment of the jejunum demonstrated intestinal lymphangiectasias as the cause of the malabsorption. These intestinal lymphangiectasias were most probably the sequela of radiotherapy 30 years earlier for testicular teratocarcinoma. Symptomatic therapy with middle chain triglycerides brought about substantially improvement.
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Affiliation(s)
- R Monasteri
- Departement Innere Medizin, Rätisches Kantons- und Regionalspital, Chur
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Rossi P, Covarelli P, Cirocchi R, Goracci G, Bartoletti MC, Fabbri C, Mosci F, Bisacci R. [Intestinal lymphangiectasis in adults]. G Chir 1996; 17:171-4. [PMID: 8754553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although rarely, several conditions may cause malabsorption through lymphatic obstruction. Primary lymphangiectasia, a genetically determined disease characterized by diarrhoea, steatorrhoea and protein-losing enteropathy, is one of these conditions. The Authors report their experience in three cases of small bowel lymphangiectasia occurring in adults and discuss diagnostic and therapeutic problems of the disease.
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Affiliation(s)
- P Rossi
- Dipartimento di Chirurgia ed Emergenze Chirurgiche, Università degli Studi di Perugia
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50
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Diaz N, Khoury A, Taboada M, Isava I, Calderon A, Lopez C, Casale E, Romer H. [Primary intestinal lymphangiectasia in children. Report of 3 cases]. G E N 1995; 49:307-9. [PMID: 8762662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It report three cases of Primary Intestinal Lymphangiectasia that presented the common symptoms of diarrhea, oedema and hipoalbuminaemia in which we could observed the clinics variations that can to present this entity. It demonstrated the importance of the intestinal biopsy to get a correct diagnosis just as the essencial of use of the medium chain triglycerides with the restriction of the common fast, to recuperate these patients.
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Affiliation(s)
- N Diaz
- Servicio de Gastroenterología, Hospital de Niños J.M. de Los Ríos
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